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PubMed1977

Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors.

In a case-control study of matched pairs, the risk of acute pelvic inflammatory disease (PID) was 4.4 times higher in intrauterine contraceptive device (IUD) users than in nonusers (p less than 0.001). Of approximately 500,000 cases of acute PID occurring annually in the United States, an estimated 110,000 are attributable to IUD's, costing over forty-four million dollars per year. PID was attributable to the IUD in 77 per cent of IUD users. No particular type of IUD was implicated. The relative risk of acute PID in IUD users over nonusers was higher in nulligravid women than in previously pregnant women and was directly related to socioeconomic status (SES), but the total annual risk of PID in IUD users appear inversely related to SES. IUD use significantly increased the risk of nongonococcal PID. Fever occurred in 13 (21 per cent) of 61 IUD users and 59 (41 per cent) of 143 nonusers (p less than 0.025). Among women with nongonococcal PID, and adnexal mass greater than or equal to 6 cm. was noted in 14 (40 per cent) of 35 IUD users and in only 12 (15 per cent) of 78 nonusers (p less than 0.01). An increased risk of gonococcal PID was found among non-Caucasians and women not using contraception, while the risk of nongonococcal PID was increased among women with a past history of gonorrhea. Oral contraceptive use may protect women with gonorrhea from developing PID. Menstruation precipitates the onset of symptoms of gonococcal PID.

Acute Disease↗
PubMed1981

Factors associated with family planning acceptance in Bangkok metropolis health clinic areas (MHCs).

To study contraceptive use in Bangkok, 6,809 eligible women were interviewed in a community survey of 5 Metropolis areas. 34.7% were current users of interval contraception and the pill was the most common method. 29.9% were not currently in need of family planning. 18.3% of women were not using contraception, but only 6.2% were in need of family planning (FP) and not currently practising contraception. Non-acceptors who were in need of FP, had a lower educational level; 13.4% did not know about contraception but 52.4% previously used contraception. The most common reason for not currently practising FP was fears about contraceptive safety (37.5%). The prevalence of pregnancy in the community was 10.4%. The fact that only 6.2% of women were not practising FP and were in need of contraception suggests that the services in Bangkok are adequate to meet the needs of most women. However, the subgroup of non-acceptors in need of FP who were from a low socio-economic group require special motivation and services. 1,835 women attending Metropolis Health Centres in the same areas were interviewed to determine their choice of contraception; 57.4% chose the pill.

Contraception Behavior↗
PubMed1987

Clinical acceptability, use-patterns and use-effectiveness of the vaginal contraceptive sponge and Neo Sampoon tablets--an international multi-center randomized clinical trial.

This paper describes the results from a randomized clinical trial comparing the Collatex vaginal contraceptive sponge (a predecessor of the Today sponge) and Neo Sampoon foaming vaginal contraceptive tablets; the trial was conducted from 1979 to 1983 in four centers located in three countries (two in Yugoslavia and one each in Taiwan and Bangladesh). The sponge was associated with more insertion and retention problems than the tablet, especially in the two Asian centers. More Neo Sampoon users complained of a burning or stinging sensation. This complaint, however, seemed to be well-tolerated and was not a frequent reason for irregular use and/or discontinuation of use of the tablets. Clinically significant medical complications were rarely reported for either method. Sponge users were more likely to report irregular use than tablet users, primarily due to inconvenience of use. Rates of discontinuation at six months of use were also consistently higher among sponge users than Neo Sampoon users in the four centers. Life-table pregnancy rates at 12 months of use ranged from 3.8 to 18.2 per 100 sponge users and 6.2 to 29.9 per 100 Neo Sampoon users, based on data from the two Yugoslavian centers and the Taiwan center (data from the Bangladesh center were excluded from analysis of pregnancy rates). Practical implications of these findings are discussed.

Adolescent↗
PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. I. Contraceptive efficacy and side effects. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

A multicentre clinical trial, including 19 centres in 13 countries, assessed the contraceptive efficacy and clinical acceptability of a Silastic 382 vaginal ring releasing 20 micrograms of levonorgestrel for at least 90 days. A total of 1005 women entered the study and 8176.74 woman-months of experience was gathered. The rate of intrauterine pregnancy at one year of use was 3.6 per 100 women (95% confidence interval 2.2-5.0), and of ectopic pregnancy, 0.2% (one case). The principal reasons for discontinuation were menstrual disturbances (17.2% at one year), vaginal symptoms (6.0%) and repeated expulsion of the ring (7.1%). The pregnancy rate with this 20 micrograms levonorgestrel-releasing vaginal ring compares favourably with that of a low estrogen combination oral contraceptive tested by WHO and is less than half that of a progestogen-only oral contraceptive in a WHO randomized study. It is concluded that the WHO intravaginal ring releasing an average of 20 micrograms of levonorgestrel per 24 hours is an effective method of contraception for at least one year of use.

Administration, Intravaginal↗
PubMed1991

Physicians' attitudes, recommendations and practice of male and female sterilization in São Paulo.

While prevalence of vasectomy is low in Brazil, female sterilization is very high. The potential for growth of vasectomy services may be related to attitudes and practices of physicians. In 1984, 660 physicians at seven major hospitals in São Paulo were randomly selected from a total population of 2207 physicians in these hospitals. They were interviewed about their attitudes towards family planning in general, and specifically towards voluntary sterilization. A high degree of vasectomy among this medical community is indicated by its relatively high prevalence among married physicians and their spouses; about one in ten reported that either they or their spouse had had a vasectomy. Half of the physicians who perform sterilizations perform vasectomies: 22% of obstetricians and gynecologists, 85% of surgeons, and all urologists. In general, physicians would recommend vasectomy and tubal ligation equally often to their clients. Depending on the circumstances, up to 85% of all physicians recommend some sterilization procedure. Recommendation was modified by the type of procedure a physician performed, and by the patient's characteristics. Physician's recommendations of sterilization increased with age and parity of patient and was related to the health conditions and socioeconomic circumstances of the couple.

Adult↗
PubMed1993

Determinants of contraceptive method choice after first delivery, before first abortion, and after first abortion in east China.

A 10% sample of the data from East China from the two-per-thousand fertility and contraception survey of the Chinese State Family Planning Committee was analysed to study determinants of contraceptive choice in three situations: after first surviving delivery; before first abortion after first surviving delivery; and after first abortion. A total of 2880 women were included. For first method choice after first delivery, the most popular method is the IUD, although there are urban/rural differences. Better educated women in urban areas prefer the condom and IUD to the pill, whereas better educated women in rural areas prefer the pill. Younger women prefer the IUD and the pill. For last method choice before first abortion, women who had no sons had apparently high failure rates on the pill.

Abortion, Induced↗
PubMed1995

Adolescent contraceptive use and its determinants in Bangladesh: evidence from Bangladesh Fertility Survey 1989.

This study is concerned with contraceptive use among the currently married adolescents in Bangladesh utilizing the 1989 Bangladesh Fertility Survey (BFS) data. The study analyzes the factors affecting the current use of contraception among the adolescents through bivariate and multivariate logistic regression analysis. The results indicate that although adolescents have almost universal knowledge about contraceptive methods, only 15 percent are currently using any method of contraception. The corresponding figures for the adults and for the nation as a whole are 34.4 percent and 31.4 percent, respectively. Among the individual methods currently used by the adolescents, the pill appears as the most popular method, followed by safe period. A substantial proportion of the adolescents were found to rely on the traditional methods of contraception. Among the socio-economic variables (as revealed by the logistic regression analysis), respondents' education, participation in the family planning decision, visit by family planning workers, region of residence, husband's occupation and possession of electricity in the household appear as the most significant factors determining the current use of contraception among the adolescents.

Adolescent↗
PubMed1995

Characteristics and experiences of American women electing for early removal of contraceptive implants.

The study describes the experiences of 430 women who had Norplant(R) contraceptive implants removed prior to the five years of method effectiveness. Each subject was surveyed when the implants were inserted and again at the time of removal. Descriptive data are presented concerning perceptions of the method before insertion and after removal, reactions to the contraceptive and experiences associated with the removal procedure. Subjects' use of Norplant implants ranged from 14 days to 40 months, with a mean of 13.3 and median of 13 months. Over 95% reported changes in menstrual bleeding patterns and 95% experienced other non-bleeding related side effects. Non-bleeding side effects were the most frequently indicated reasons for removal, followed by bleeding changes. The mean removal time was 34 minutes with a median of 25 minutes. Over 48% reported experiencing significant pain during the removal procedure, and 27% stated that the pain was greater than expected. Despite electing for early removal of implants,the majority of women surveyed indicated satisfaction with all aspects of the method save its effect on their overall health. Although method-related side effects were intolerable for most subjects, their overall perception of the method was generally satisfactory.

Adolescent↗
PubMed1985

The effect of oral contraceptive formulation and field-workers: a cautionary tale.

This paper examines oral contraceptive continuation rates and reported side effects in a large scale clinical research project conducted in Sri Lanka. The project evaluated standard- and low-dose pills used with and without vitamin supplements. Differences in continuation rates and perception of side effects are used to illustrate the impact that family planning field-workers can have on women's use of oral contraceptives.

Attitude↗
PubMed1995

Contraceptive use and the risk of HIV infection in Nairobi, Kenya.

OBJECTIVES: To determine: (a) the prevalence of human immunodeficiency virus-1 (HIV-1) infection among women attending family planning clinics in Nairobi; and (b) the associations between contraceptive use and HIV infection. METHODS: History, clinical examination and laboratory tests were used to obtain data from 4404 women attending family planning clinics in Nairobi. We conducted a case-control study comparing HIV seropositive and seronegative women with regard to previous and current use of contraception. RESULTS: The overall prevalence of HIV-1 infection was 4.9% (95% C.I. 4.3-5.5). Previous and current use of oral contraceptives (OC), injectable contraceptives and the intrauterine device were not associated with a significant increase in risk, while current users of condoms had a non-significant reduction in risk. OC use was significantly associated with cervical ectopy, but no significant association was evident between ectopy and HIV infection. CONCLUSION: The finding of no significant association between past or current OC use and risk of HIV infection suggests that any independent association that may exist between OC use and HIV risk is not large.

Adolescent↗
PubMed1995

The impact of knowledge of human immunodeficiency virus serostatus on contraceptive choice and repeat pregnancy.

OBJECTIVE: To examine relationships among human immunodeficiency virus (HIV) serostatus, postpartum contraceptive choice, and the rate of repeat pregnancy within a short interval. METHODS: This retrospective cohort study was performed in 83 seropositive and 218 seronegative women identified from an inner-city prenatal population undergoing routine voluntary HIV antibody screening from July 1987 through June 1989. Postpartum contraceptive choices and rate of repeat pregnancies were compared based on HIV serostatus. RESULTS: Seropositive women were significantly more likely than seronegative women to undergo tubal sterilization (27 versus 15%; odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.9). This relationship persisted after controlling for age, race, marital status, and parity by logistic regression modeling (adjusted OR 2.9, 95% CI 1.4-5.9). Seropositive women were significantly less likely than seronegative women to select oral contraceptives (34 versus 68%; OR 0.2, 95% CI 0.1-0.4), a relationship that persisted after controlling for age, race, marital status, parity, and foam and condom use (adjusted OR 0.2, 95% CI 0.1-0.5). Seropositive women were significantly more likely than seronegative women to select foam and condoms as their primary method of contraception (30 versus 15%; OR 2.4, 95% CI 1.2-4.5), a relationship that did not persist after controlling for age, race, marital status, and parity (adjusted OR 0.7, 95% CI 0.4-1.3). The risk of repeat pregnancy was slightly lower in seropositive versus seronegative women (34 versus 44%; OR 0.7, 95% CI 0.4-1.3). Most repeat pregnancies among seropositive and seronegative women were unplanned (90 and 82%, respectively). CONCLUSION: There was a relationship between the method of postpartum contraception and HIV serostatus, but no significant difference in repeat pregnancy rates associated with choice of method.

Adolescent↗
PubMed1995

Relationship between use of condoms and other forms of contraception among human immunodeficiency virus-infected women. Supplement to HIV and AIDS Surveillance Project Group.

OBJECTIVE: To describe the relationship between condom use and use of other contraceptives among human immunodeficiency virus (HIV)-infected women. METHODS: We interviewed 1232 women, 18-50 years of age, who had had sex with a man in the prior 12 months and who were reported with AIDS or HIV to local health departments in 12 states and cities in the United States. These women were asked about condom use and other contraceptive use in the past year. RESULTS: Forty-seven percent of women reported using condoms as a form of contraception in the past 12 months. Thirty-four percent of the 286 women who had had a tubal ligation and 42% of the 182 women who used oral contraceptives (OC) used condoms. When we controlled for all factors associated with failing to use condoms, women who had had a tubal ligation (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] 1.28-2.33), women who used OCs (adjusted OR 1.44, CI 1.00-2.08), and women who were unaware of the HIV status of their most recent steady sex partner (adjusted OR 1.72, CI 1.28-2.31) were the least likely to use condoms. CONCLUSION: Human immunodeficiency virus-infected women who used more effective contraceptive methods were the least likely to have male sex partners who used condoms. In counseling women at high risk of transmitting HIV, health care providers should discuss reasons for using contraceptives (ie, preventing pregnancy versus preventing HIV transmission) and ensure that women understand that different forms of contraceptives may be needed to achieve those different purposes.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Factors affecting the consistent use of barrier methods of contraception.

OBJECTIVES: To discuss the major issues involved in the consistent and effective use of barrier methods of contraception. DATA SOURCES: Major research and review articles on barrier methods published within the last 10 years were considered. One major source of articles was Family Planning Perspectives. METHODS OF STUDY SELECTION: This paper is a focused review and integration of recent literature rather than a comprehensive literature review. Only selected articles published since 1986 that are pertinent to the issues raised are included. TABULATION, INTEGRATION, AND RESULTS: All barrier methods have common characteristics that influence their patterns of use. The correct and consistent use of such methods is determined by the complex interaction of characteristics of the methods themselves, characteristics of users, and the situational context. Method characteristics include the extent of interference with sexual spontaneity and enjoyment, the amount of partner cooperation required, and the ability of the method to protect against human immunodeficiency virus and other sexually transmitted diseases. User characteristics include motivation to avoid unintended pregnancy, ability to plan, comfort with sexuality, and previous contraceptive use. Stage of sexual career, relationship characteristics, and physical and sexual abuse are important situational influences. CONCLUSIONS: Even though most barrier methods can be obtained without a prescription from a provider, clinicians have an extremely important role in promoting effective and consistent method use. Four major ways to improve the use of barrier methods currently available include: 1) improve method characteristics and the distribution systems; 2) change consumers' perceptions of method attributes; 3) train consumers to use methods correctly and overcome-perceived negative characteristics of the methods; and 4) change values about the perceived importance of method characteristics. There also is an urgent need for the development of better barrier methods.

Adolescent↗
PubMed1996

Compliance with contraceptives and other treatments.

OBJECTIVE: To define some of the issues unique to compliance with oral contraceptives, and some comparisons with other preventive and therapeutic treatments. DATA SOURCES: Reports of compliance with medical treatment were used, with a focus on studies using microelectronic monitoring to assess compliance. Studies included the general population and a variety of demographically different groups. METHODS OF STUDY SELECTION: Twenty-nine studies of medication compliance (including surveys and clinical trials with specific interventions), across a broad range of medical disorders, were selected for comparison with reports of oral contraceptive compliance. TABULATION, INTEGRATION, AND RESULTS: Rates of compliance with contraceptive methods are low, but differ little from rates of compliance with other medical treatments. Several questions might be used to ascertain the likelihood that an individual is willing to use an oral contraceptive as prescribed (eg, willingness to take a daily pill, to return for follow-up, and to report adverse effects). CONCLUSIONS: Studies of a variety of medical disorders have shown that no consequence is so severe that all patients can be assumed to comply with the prescribed treatment plan. Inadequate compliance often diminishes treatment efficacy, which suggests the need for alternative methods that do not require daily compliance.

Adolescent↗
PubMed2006

Contraceptive use and discontinuation: findings from the contraceptive history, initiation, and choice study.

OBJECTIVE: The purpose of this study is to provide insight on the continuing high rate of unintended pregnancy among adult women. STUDY DESIGN: Contracepting women were recruited while they waited for primary care appointments. A total of 369 completed the baseline questionnaire, and 145 oral contraceptive (OC) users were enrolled in a 5-week, diary-based study of adherence and sexual activity. RESULTS: Most women who reported having discontinued OCs did so because of medical side effects, and most had switched to less effective methods. Among OC users, 26.4% had sexual intercourse on days they missed pills just before or after their placebo week. Nonadherence did not differ by socioeconomic factors or obesity. CONCLUSION: Clinicians may need to encourage their patients to discuss their reasons for wanting to discontinue the use of an effective contraceptive method and assist them with their concerns or to switch to other effective methods to protect themselves from unintended pregnancy.

Adult↗
PubMed2004

Emergency contraception: what do our patients know?

STUDY OBJECTIVE: Unintended pregnancy is a major medical, social, and public health problem. Emergency contraceptive pills can prevent 75% to 85% of unintended pregnancies if administered within 72 hours of intercourse. We perform this study to measure knowledge, attitudes, practices, and perceived needs about emergency contraception in a sample of women seeking emergency department (ED) care. METHODS: This was a prospective survey of women presenting to an inner-city ED during an 8-week study period. Women who were aged 18 to 45 years, English speaking, and not critically ill and who presented during 56 randomly generated 4-hour time blocks were eligible. Trained research assistants administered a 20-question survey that included questions on current sexual and contraceptive practices and knowledge, acceptance, and preferences about postcoital contraception. RESULTS: Two hundred thirty-two women met eligibility criteria; 158 (68%) women agreed to participate. Participants and nonparticipants were similar in age, race, ethnicity, and insurance status. The participants' mean age was 30 years. Twenty-five percent were married, whereas 49% had never married and 25% were separated or divorced. Fifty-two percent (95% confidence interval [CI] 44% to 60%) reported at least 1 previous unintended pregnancy; 28% (95% CI 21% to 35%) had 1 or more previous elective abortions. Of women who had been sexually active in the past month, half (47%) reported unprotected intercourse during that time. Among all respondents, 122 (77%; 95% CI 71% to 84%) had heard of emergency contraception as a way of preventing pregnancy after unprotected intercourse. Of these respondents, one fourth to one half did not have enough knowledge to use emergency contraceptive pills effectively. Fifty-seven percent of women were willing to use emergency contraceptive pills in the future, and 16 women said they would consider a change in regular contraception to emergency contraceptive pills if widely available. CONCLUSION: Sexually active women seeking ED care have high rates of unintended pregnancy and abortion. There is broad acceptance of emergency contraceptive pills to prevent pregnancy, but knowledge of availability, timing, and proper use is limited. Emergency contraceptive pills are a safe, effective, and low-cost primary preventive and emergency care intervention, and information about their use should be made available to ED patients. Patients should be advised not to abandon their use of barrier or other traditional contraceptives.

Adolescent↗